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I need help! We have multiple primary care providers that have been hit as outliers from BCBS. BCBS is down coding our charge of 99214 to 99213. We have been sending medical notes left and right and have had great success in getting many of the edit overturned, however, still running into denials for LOS and our auditors are adamant that our coding is correct. I have an example below of an exam that we billed 99214 that BCBS denied stating" the overall level of MDM is not supported in the documentation". Would anyone mind taking a look and giving some feedback? What level of service would you bill? I would greatly appreciate it!
Assessment & Plan (Diagnostic & Therapeutic):
Mixed anxiety and depressive disorder (Primary)
Assessment & Plan:
Stable
Well-controlled off medications
Continue to monitor
Attention deficit hyperactivity disorder (ADHD), combined type
Assessment & Plan:
Stable
PDMP website reviewed
Collaborated with Dr. XXXX
Refill Adderall XR 20 mg p.o. daily
Follow-up 2 months
Orders:
- Discontinue: amphetamine-dextroamphetamine XR (ADDERALL XR) 20 mg 24 hr capsule; Take 1 capsule (20 mg total) by mouth daily.
- amphetamine-dextroamphetamine XR (ADDERALL XR) 20 mg 24 hr capsule; Take 1 capsule (20 mg total) by mouth daily.
Psoriatic arthritis (CMS/HCC)
Assessment & Plan:
Stable
Continue methotrexate 10 mg subcu weekly injection
Recommend patient follow-up with rheumatology,
Chief Complaint:
XXXXX is a 33 y.o. here for ADHD
History of Present Illness and Interval History:
33-year-old presents office today to follow-up on ADHD and psoriatic arthritis. Patient doing well on current medications.
Review of Systems:
Review of Systems
Constitutional: Negative.
HENT: Negative.
Dry eyes
Eyes: Negative.
Respiratory: Negative.
Cardiovascular: Negative.
Gastrointestinal: Negative.
Genitourinary: Negative.
Musculoskeletal: Negative.
Skin: Negative.
Neurological: Negative.
Psychiatric/Behavioral: Negative.
ADHD
Physical Exam:
Vitals
Vitals:
05/24/21 1627
BP: 122/80
Pulse: 88
Resp: 18
SpO2: 98%
Weight: 70.3 kg (155 lb)
Height: 1.676 m (5' 6")
Body mass index is 25.02 kg/m².
Body surface area is 1.81 meters squared.
Physical Exam
Vitals and nursing note reviewed.
Constitutional:
Appearance: She is well-developed and well-nourished.
HENT:
Right Ear: Tympanic membrane, ear canal and external ear normal.
Left Ear: Tympanic membrane, ear canal and external ear normal.
Nose: Nose normal.
Mouth/Throat:
Mouth: Mucous membranes are moist.
Pharynx: Oropharynx is clear.
Eyes:
Pupils: Pupils are equal, round, and reactive to light.
Cardiovascular:
Rate and Rhythm: Normal rate and regular rhythm.
Heart sounds: S1 normal and S2 normal.
Pulmonary:
Effort: Pulmonary effort is normal.
Breath sounds: Normal breath sounds.
Abdominal:
General: Bowel sounds are normal.
Skin:
General: Skin is dry.
Capillary Refill: Capillary refill takes less than 2 seconds.
Neurological:
Mental Status: She is alert and alert and oriented to person, place, and time.
Psychiatric:
Mood and Affect: Mood and affect normal.
Return in about 2 months (around 7/24/2021).
After Visit Summary (Printed 5/24/2021)
Assessment & Plan (Diagnostic & Therapeutic):
Mixed anxiety and depressive disorder (Primary)
Assessment & Plan:
Stable
Well-controlled off medications
Continue to monitor
Attention deficit hyperactivity disorder (ADHD), combined type
Assessment & Plan:
Stable
PDMP website reviewed
Collaborated with Dr. XXXX
Refill Adderall XR 20 mg p.o. daily
Follow-up 2 months
Orders:
- Discontinue: amphetamine-dextroamphetamine XR (ADDERALL XR) 20 mg 24 hr capsule; Take 1 capsule (20 mg total) by mouth daily.
- amphetamine-dextroamphetamine XR (ADDERALL XR) 20 mg 24 hr capsule; Take 1 capsule (20 mg total) by mouth daily.
Psoriatic arthritis (CMS/HCC)
Assessment & Plan:
Stable
Continue methotrexate 10 mg subcu weekly injection
Recommend patient follow-up with rheumatology,
Chief Complaint:
XXXXX is a 33 y.o. here for ADHD
History of Present Illness and Interval History:
33-year-old presents office today to follow-up on ADHD and psoriatic arthritis. Patient doing well on current medications.
Review of Systems:
Review of Systems
Constitutional: Negative.
HENT: Negative.
Dry eyes
Eyes: Negative.
Respiratory: Negative.
Cardiovascular: Negative.
Gastrointestinal: Negative.
Genitourinary: Negative.
Musculoskeletal: Negative.
Skin: Negative.
Neurological: Negative.
Psychiatric/Behavioral: Negative.
ADHD
Physical Exam:
Vitals
Vitals:
05/24/21 1627
BP: 122/80
Pulse: 88
Resp: 18
SpO2: 98%
Weight: 70.3 kg (155 lb)
Height: 1.676 m (5' 6")
Body mass index is 25.02 kg/m².
Body surface area is 1.81 meters squared.
Physical Exam
Vitals and nursing note reviewed.
Constitutional:
Appearance: She is well-developed and well-nourished.
HENT:
Right Ear: Tympanic membrane, ear canal and external ear normal.
Left Ear: Tympanic membrane, ear canal and external ear normal.
Nose: Nose normal.
Mouth/Throat:
Mouth: Mucous membranes are moist.
Pharynx: Oropharynx is clear.
Eyes:
Pupils: Pupils are equal, round, and reactive to light.
Cardiovascular:
Rate and Rhythm: Normal rate and regular rhythm.
Heart sounds: S1 normal and S2 normal.
Pulmonary:
Effort: Pulmonary effort is normal.
Breath sounds: Normal breath sounds.
Abdominal:
General: Bowel sounds are normal.
Skin:
General: Skin is dry.
Capillary Refill: Capillary refill takes less than 2 seconds.
Neurological:
Mental Status: She is alert and alert and oriented to person, place, and time.
Psychiatric:
Mood and Affect: Mood and affect normal.
Return in about 2 months (around 7/24/2021).
After Visit Summary (Printed 5/24/2021)